Express Scripts provides pharmacy benefits for all five medical plans. Copays and deductibles vary depending on the type of medicine prescribed (generic, brand or non-formulary), the length of the prescriptions, and whether you purchase at a retail pharmacy, through the Express Scripts mail order pharmacy, or through participating on-site Duke Pharmacies (Duke Outpatient Pharmacy, Duke Children's Health Center Retail Pharmacy, Campus Center Pharmacy at the Student Wellness Center, Duke Specialty Pharmacy at the Cancer Center, Duke Raleigh Hospital Plaza Pharmacy, Duke Regional Hospital Outpatient Pharmacy, and North Pavilion Retail Pharmacy).
Specialty medications must be purchased through Accredo® or the Duke Specialty Pharmacy to be eligible for coverage under the plan, unless they are medications which are intended for an immediate need. See Pharmacy Benefits for a listing of "Specialty" medications.
Review the chart below to understand how filling your recurring, long-term medications through the mail order program or participating on-site Duke Pharmacies can save you money.
Express Scripts (pharmacy manager)
express-scripts.com
Toll-free (800) 717-6575
| At a participating retail pharmacy | Through the Express Scripts Mail Order Pharmacy or Participating on-site Duke Pharmacies | |
|---|---|---|
| Up to a 34-day supply | 90-day supply | |
| Generic No deductible except for participants covered by Duke Basic. | First three purchases of any medication: $15 (or cost of drug if less) After the third purchase of a long-term medication: 50%* (cost of drug to max. $30) | $25 (or cost of drug if less) |
| Brand Annual $100 per person retail deductible applies. No deductible for 90-day supply through mail order or on-site Duke Pharmacies except for Duke Basic participants. | First three purchases of any medication: $50 After the third purchase of a long-term medication: 50%* (Min. $70, Max. $165) | $130 |
| Non-formulary Annual $100 per person retail deductible applies. No deductible for 90-day supply through mail order or on-site Duke Pharmacies except for Duke Basic participants. | First three purchases of any medication: $70 After the third purchase of a long-term medication: 50%* (Min. $85, Max. $180) | $180 |
*Duke Basic participants are required to use the mail order or on-site Duke Pharmacies for long-term medications.
Participants in the Duke Basic medical plan have a $100 annual deductible for all prescription drugs (except for certain contraceptive drugs) including generic and mail-order prescriptions. Duke Basic participants are required to use mail order or Duke Pharmacies for long-term medications.
Participants in Duke Select, Blue Care, Duke Options, and Duke USA have an annual $100 deductible per person that applies to short-term brand and non-formulary prescriptions filled at retail pharmacies and on-site Duke pharmacies.
Members are encouraged to use generic medications when a generic substitution is an option. Those who elect to use a brand-name medication when a generic medication is available will pay a higher cost in addition to the brand-name copay. If a generic drug is available but you request to receive the brand-name drug, you will pay the generic copay plus the difference between the cost of the two drugs, regardless of where the prescription is being filled. This applies to prescription drugs purchased at retail, through Duke pharmacies, and through Express Scripts home delivery (mail order).
Certain contraceptive drugs are covered at no cost to the member. More information is available at the Pharmacy Benefits website.
Injectable fertility drugs are not reimbursed according to our standard pharmacy benefit. Only plans covering infertility services include coverage of these drugs, which must be prescribed by a Duke Fertility physician for those members residing in North Carolina. More information is available at the Infertility Benefits website.
Certain specialty pharmacy drugs are considered non-essential health benefits under the plan, and the cost of these drugs will not be applied toward a member's out-of-pocket maximum. Although the cost of these eligible specialty drugs will not be applied towards the out-of-pocket maximum, these costs will be reimbursed by the manufacturer at no cost to the member. A list of specialty medications eligible for this program is available online.